Effects of mindful eating training on delay and probability discounting for food and money in obese and healthy-weight individuals

Impact of self-rationing on academic performance of college students

OBJECTIVE

Self-rationing or one's ability to regulate allocation of resources for consumption can be an inefficient process. Despite the negative impact of self-rationing inefficiencies (eg unhealthy food choices), there is scarce research to understand this phenomenon. This study investigated college students' self-rationing efficiency of eating behavior and spending choices, and their relationship to academic performance.

PARTICIPANTS AND METHODS

This study used a combination of a real-time experiment, self-reported surveys (n = 101), and interviews with college students (n = 12). Data was collected using two 24-hour recall periods, online surveys, and semi-structured interviews.

RESULTS

College students demonstrated self-rationing inefficiency of eating behavior, but not of expenditure on food. Furthermore, there was a significant relationship between self-rationing inefficiencies in eating behavior and students' academic performance.

CONCLUSIONS

This study directly investigated self-rationing efficiency amongst college students' food choices and food expenditure, and enhances our understanding of its impact on college students' academic performance.

Body appreciation and mindful eating in Lebanese adults: the mediating role of psychological distress

A gap in the literature exists about the associations between adaptive eating patterns like mindful eating, body appreciation and psychological distress within the Lebanese population. The current culture of acceptance and increased emphasis on wellbeing elicits interest in studying body acceptance and its correlates. The aim of the current study is to assess the mediating effect of psychological distress in the association between body appreciation and mindful eating behaviors among a sample of Lebanese adults. This cross-sectional study enrolled 465 participants. Men and women over the age of 18 were eligible to participate. Then, initial participants were asked to recruit other participants they know. Individuals who consented took an online questionnaire that contained the following scales: a section collecting sociodemographic information, Mindful Eating Behavior Scale, Depression Stress Anxiety Scale (DASS-8) and Body Appreciation (BAS-2). The results of the mediation analysis showed that psychological distress fully mediated the associations between body appreciation and eating with awareness/eating without distraction. Higher body appreciation was significantly associated with less psychological distress, whereas higher psychological distress was significantly associated with less eating with awareness/eating without distraction. However, body appreciation was not associated with eating with awareness/eating without distraction respectively. These findings could guide further research on different categories of adaptive eating patterns and positive body variables within the Lebanese population.

Discounting of Hyper-Palatable Food and Money: Associations with Food Addiction Symptoms

INTRODUCTION

Delay discounting (DD), the tendency to prefer small, immediate rewards over larger, delayed rewards, is associated with health-risk behaviors. The study examined associations between DD for money and hyper-palatable foods (HPF) with food addiction (FA) symptoms among a general population sample.

METHODS

Participants (N = 296) completed an adjusting DD task that consisted of a single-commodity condition with HPF as the reward (HPF now vs. HPF later) and cross-commodity conditions comparing money and HPF (money now vs. HPF later; HPF now vs. money later). The Yale Food Addiction Scale 2.0 was used to assess FA symptoms. Zero-inflated negative binomial regression models tested whether discounting of HPF and money was associated with FA symptoms.

RESULTS

Findings indicated there were no significant associations between DD and FA symptoms in the single-commodity HPF condition (logit: OR = 1.02, p-value = 0.650; count: IRR = 1.04, p-value = 0.515). There were no significant associations among cross-commodity conditions comparing money now vs. HPF later (logit: OR = 0.96, p-value = 0.330; count: IRR = 1.02, p-value = 0.729) or conditions comparing HPF now vs. money later (logit: OR = 1.02, p-value = 0.682; count: IRR = 0.92, p-value = 0.128) and FA symptoms.

CONCLUSIONS

Discounting HPF may not be a key behavioral feature among individuals who endorse FA symptoms.

COVID-19-related financial scarcity is associated with greater delay discounting but not probability discounting

Prior studies suggest that scarcity increases delay discounting (devaluation of delayed outcomes) and disturbs other decision-making processes. Evidence on the effect of COVID-19 on delay discounting is mixed. Also, no study has examined the effect of COVID-19-related scarcity on probability discounting (devaluation of probabilistic outcomes). The goal of the study was to examine cross-sectional associations between financial impact during the COVID-19 pandemic, delay discounting, and probability discounting. During April 2020, 1012 participants with low income were recruited on Amazon Mechanical Turk and completed measures of delay and probability discounting, perceived COVID-19-related financial impacts, and food security. Regression analyses indicate that compared to those with no COVID-19-related financial impacts, those with severe COVID-19-related financial impacts had greater delay discounting of money and greater delay discounting of a grocery gift card. Also, greater food insecurity in the past month was associated with greater delay discounting of a grocery gift card but not delay discounting of money. Perceived COVID-19 related financial impact was not associated with probability discounting. Combined with laboratory experiments, this study provides additional support for the idea that feelings of scarcity may increase delay discounting. However, as this study was observational, no assumptions of causality should be made about the specific effect of COVID-19 on delay discounting.

The effects of an 8-week mindful eating intervention on anticipatory reward responses in striatum and midbrain

Introduction

Accumulating evidence suggests that increased neural responses during the anticipation of high-calorie food play an important role in the tendency to overeat. A promising method for counteracting enhanced food anticipation in overeating might be mindfulness-based interventions (MBIs). However, the neural mechanisms by which MBIs can affect food reward anticipation are unclear. In this randomized, actively controlled study, the primary objective was to investigate the effect of an 8-week mindful eating intervention on reward anticipation. We hypothesized that mindful eating would decrease striatal reward anticipation responses. Additionally, responses in the midbrain-from which the reward pathways originate-were explored.

Methods

Using functional magnetic resonance imaging (fMRI), we tested 58 healthy participants with a wide body mass index range (BMI: 19-35 kg/m2), motivated to change their eating behavior. During scanning they performed an incentive delay task, measuring neural reward anticipation responses to caloric and monetary cues before and after 8 weeks of mindful eating or educational cooking (active control).

Results

Compared with the educational cooking intervention, mindful eating affected neural reward anticipation responses, with reduced caloric relative to monetary reward responses. This effect was, however, not seen in the striatum, but only in the midbrain. The secondary objective was to assess temporary and long-lasting (1 year follow-up) intervention effects on self-reported eating behavior and anthropometric measures [BMI, waist circumference, waist-to-hip-ratio (WHR)]. We did not observe effects of the mindful eating intervention on eating behavior. Instead, the control intervention showed temporary beneficial effects on BMI, waist circumference, and diet quality, but not on WHR or self-reported eating behavior, as well as long-lasting increases in knowledge about healthy eating.

Discussion

These results suggest that an 8-week mindful eating intervention may have decreased the relative salience of food cues by affecting midbrain but not striatal reward responses, without necessarily affecting regular eating behavior. However, these exploratory results should be verified in confirmatory research.The primary and secondary objectives of the study were registered in the Dutch Trial Register (NTR): NL4923 (NTR5025).

Food Appreciation Scale Development and Dimensionality Assessment

Food appreciation has been associated with favorable dietary and food waste behaviors. However, no validated food appreciation assessment currently exists. This study aimed to develop and validate a food appreciation scale (FAS) using data from two independent US-based samples recruited online. The 29-item FAS was based on existing literature regarding appreciation as a psychological construct, mindful eating, and epicurean tendencies. In Study 1, 311 participants completed the FAS, and exploratory factor analysis (EFA) was conducted. In Study 2, 300 participants completed the FAS, and confirmatory factor analysis (CFA) was conducted to determine whether the factor structure remained consistent. The EFA indicated a good model fit for a four-factor structure after excluding six items that loaded on multiple or no factors (TLI 0.95, CFI 0.97, SRMR 0.03, RMSEA 0.05), and Cronbach's alpha indicated excellent reliability (Cronbach's alpha values 0.82-0.9). The CFA confirmed the four-factor structure (TLI 0.97, CFI 0.98, SRMR 0.08, RMSEA 0.05) and acceptable factor loadings with a simple structure. The factors assessed active food appreciation, reflective food appreciation, mindful epicurean tendencies, and food-related rituals. The validated FAS could allow researchers to assess food appreciation, measure changes in food appreciation over time, and compare food appreciation among different study populations.

The spectrum of eating environments encountered in free living adults documented using a passive capture food intake wearable device

Introduction

The aim of this feasibility and proof-of-concept study was to examine the use of a novel wearable device for automatic food intake detection to capture the full range of free-living eating environments of adults with overweight and obesity. In this paper, we document eating environments of individuals that have not been thoroughly described previously in nutrition software as current practices rely on participant self-report and methods with limited eating environment options.

Methods

Data from 25 participants and 116 total days (7 men, 18 women, Mage = 44 ± 12 years, BMI 34.3 ± 5.2 kg/mm2), who wore the passive capture device for at least 7 consecutive days (≥12h waking hours/d) were analyzed. Data were analyzed at the participant level and stratified amongst meal type into breakfast, lunch, dinner, and snack categories. Out of 116 days, 68.1% included breakfast, 71.5% included lunch, 82.8% included dinner, and 86.2% included at least one snack.

Results

The most prevalent eating environment among all eating occasions was at home and with one or more screens in use (breakfast: 48.1%, lunch: 42.2%, dinner: 50%, and snacks: 55%), eating alone (breakfast: 75.9%, lunch: 89.2%, dinner: 74.3%, snacks: 74.3%), in the dining room (breakfast: 36.7%, lunch: 30.1%, dinner: 45.8%) or living room (snacks: 28.0%), and in multiple locations (breakfast: 44.3%, lunch: 28.8%, dinner: 44.8%, snacks: 41.3%).

Discussion

Results suggest a passive capture device can provide accurate detection of food intake in multiple eating environments. To our knowledge, this is the first study to classify eating occasions in multiple eating environments and may be a useful tool for future behavioral research studies to accurately codify eating environments.

Translation and validation of the mindful eating behaviour scale in the Arabic language

BACKGROUND

There has been a drastic increase in the prevalence of obesity and its related diseases in the Arabic-speaking countries during the last decades along with a lack of public awareness about this awareness about this public health problem. This calls for the development of novel prevention and intervention strategies that are based on new approaches, including mindful eating. In this context, we aimed through this study to explore the factor structure, composite reliability, measurement invariance across sex, convergent and divergent validity of an Arabic translation of the Mindful Eating Behaviour Scale (MEBS).

METHODS

A cross-sectional study carried out between September and November 2022, and enrolled 359 participants, all aged above 18 years old and recruited from all Lebanon governorates. The questionnaire used included socio-demographic questions, and the following scales: The Mindful Eating Behavior Scale (MEBS), Rosenberg Self-Esteem Scale (RSES), Intuitive Eating Scale-2, and Depression Anxiety Stress Scale (DASS-8).

RESULTS

McDonald's ω values ranged from .82 to .95 or the four mindful eating domains, indicating the excellent internal consistency reliability of the scale. Our study also showed that fit indices from the confirmatory factor analysis confirmed the original four-factor structure model of the MEBS. Furthermore, our analyses suggested that configural, metric, and scalar invariance was supported across sex. Our results found no sex difference in all MEBS subscales scores. Finally, we found positive correlations between Focused eating, Hunger and satiety cues on one hand, and intuitive eating on the other hand. Moreover, greater Hunger and satiety cues scores were correlated with higher self-esteem and lower body mass index.

CONCLUSION

Our findings support the psychometric reliability and validity of the Arabic MEBS. We suggest, accordingly, that the scale will be of high clinical and research utility, and will help in the development of information-based interventions focused on mindful eating that are aimed to combat eating disorders and obesity in the Arab world.

BARIMEP: A TOOL FOR TRAINING BARIATRIC SURGERY PATIENTS

ABSTRACT BACKGROUND Bariatric surgery patients have symptoms such as “plugging.” Therefore, a possible good way to avoid these eating discomforts, typical of the early period after bariatric surgery, is to educate the patient. The Mindful Eating (ME) consists of paying attention to physical signs of hunger and satiety and developing awareness of emotional triggers related to food. In addition, conscious food choices reflect positively on the speed of chewing at mealtime. AIMS Due to the difficulties that patients reported during consultations to controlling their bad eating habits and the lack of tools to help the bariatric patient change eating habits, we elaborated “BariMEP: A Mindful Eating Placemat for bariatric surgery patients.” METHODS The BariMEP was written by the multidisciplinary bariatric team based on a study by Russell et al. and ME principles in order to help bariatric patients pay attention to what and how they eat at each meal. RESULTS The BariMEP has some instructions based on Mindful Eating principles: get your seat at the table; do not distract yourself; before starting to eat, try breathing sometimes; recognize the internal hunger and satiety cues; let the fork rest at each bite and chew a lot; pay attention to the smell and taste; and be as present as possible at this time with nonjudgment. CONCLUSIONS For the first time, a tool has been developed with the aim of preparing the patient for bariatric surgery. Since the BariMEP is easy to teach and cheap, we suggest that the BariMEP be included in the bariatric surgery protocol.

The impact of mindfulness meditation on social and moral behavior: Does mindfulness enhance other-oriented motivation or decrease monetary reward salience?

This perspective article provides an overview of the impact of mindfulness meditation (MM) on social and moral behavior. In mindfulness research, prosocial behavior has been operationalized as helping behavior, altruistic redistribution of funds, reparative behavior, or monetary donation. Studies concerning moral behavior are still scarce. Despite inconsistent evidence, several studies found a beneficial effect of mindfulness on prosocial outcomes (i.e., a higher propensity to spend or give away money for the sake of other individuals). However, since the employed tasks were reward-based, participants’ decisions also directly affected their own payoff by reducing it. Crucially, MM also affects self-control circuitry and reduces reward-seeking behaviors and reward salience by making rewards less tempting. We have discussed evidence suggesting how challenging it may be to dissociate the specific weight of enhanced other-oriented motivation from one of the decreased monetary reward salience in explaining meditators’ behavior. Future higher-quality studies are needed to address this open issue.

Mindful Eating Questionnaire: Validation and Reliability in Romanian Adults

Mindful eating may play an important role in long-term weight maintenance. In interventions aiming at weight reduction, increasing the levels of mindful eating was associated with higher levels of success and lower levels of weight rebound in the long run. This study aimed to determine the validity and reliability of a mindful eating questionnaire for Romanian adults using Framson's Mindful Eating Questionnaire (MEQ). To calculate the internal (n = 495) and external (n = 45) reliability, a general population sample was taken. Construct validity was assessed using the "known groups" method: dietitians (n = 70), sports professionals (n = 52), and individuals with overweight and obesity (n = 200). Convergent validity tested the association between the MEQ score and demographic characteristics of the total sample (n = 617). The internal (0.72) and external (0.83) reliability were adequate. Dietitians and sports professionals had overall lower scores, meaning more mindful eating compared to the group of individuals with overweight and obesity. The lower mindful eating practice was associated with the presence of excess weight, suboptimal health status perception, higher levels of stress and younger age. The Romanian version of the MEQ is a reliable and valid tool for measuring mindfulness of eating in adults.

Everyday discrimination as a predictor of maladaptive and adaptive eating: Findings from EAT 2018

Various types of stressors are associated with maladaptive eating, but how the stressor of everyday discrimination (e.g., less respect, poorer service) relates to maladaptive eating and adaptive eating remains unclear. We examined everyday discrimination as a predictor of maladaptive and adaptive eating. Data were collected in a population-based study, Eating and Activity over Time (N = 1410, ages 18-30). Everyday discrimination was categorized as none, low, moderate, or high. Outcomes included maladaptive eating (i.e., overeating and binge eating) and adaptive eating (i.e., intuitive eating and mindful eating). Modified Poisson regressions estimated the prevalence ratios (PRs) for overeating and binge eating associated with everyday discrimination. Linear regressions estimated associations between everyday discrimination and intuitive and mindful eating scores. After adjustment for age, ethnicity/race, gender, and socioeconomic status, moderate and high levels of discriminatory experiences were each associated with a significantly greater prevalence of binge eating (PR = 2.2, [95% CI = 1.3-3.7] and PR = 3.1, [95% CI = 2.0-4.7], respectively) and lower intuitive (β = -0.4, [95% CI = -0.7, -0.2] and β = -0.5 [95% CI = -0.8, -0.3], respectively), and mindful eating scores (β = -0.3, [95% CI = -0.6, -0.1] and β = -0.5 [95% CI = -0.8, -0.3], respectively) compared to young adults with no discriminatory experience. Public health efforts to prevent maladaptive eating and encourage the adoption of adaptive eating should consider the potential contribution of everyday discrimination and the need to advocate for equity and inclusion.

Age-related effects in delay discounting for food

Developmental influences of growth, such as hormones and metabolic factors, increase food intake and weight across the lifespan. Delay discounting (DD), a choice procedure that characterizes preferences for immediate rewards, such as food, over larger, more delayed ones may be useful in understanding developmental and metabolic changes in decision making processes related to food intake. The present study examined the relation between age and food DD in a cross-sectional design. Other variables, such as pubertal stage, were examined also as these may influence discounting. Participants (N = 114; 28 children and 86 adult) from a community sample completed measures of food and money delay discounting to determine if age-related variation in discounting tendencies is food-specific or more general. Both measures yield an omnibus discounting value and three additional values for small, medium, and large magnitudes. Analyses first revealed magnitude effects-- smaller magnitudes of both food and money were discounted more steeply than larger magnitudes. Hierarchical regressions indicated subjective hunger predicted steeper food discounting. When subjective hunger was controlled, age, but not puberty, significantly predicted food discounting for omnibus, medium, and large magnitudes of food. In children, food discounting decreased from early childhood to late adolescence. In adults, food discounting increased from early to late adulthood. Neither age, puberty, nor obesity status predicted any measure of monetary discounting. Food discounting, then, appears to change across the lifespan, and therefore, may be appropriate to examine psychological processes that accompany developmental and metabolic changes across the lifespan.

Mindfulness-based intervention in adolescents at risk for excess weight gain: 1.5-year follow-up of pilot randomized controlled trial

BACKGROUND

Mindfulness-based intervention (MBI) may offer a novel means of preventing excess weight gain in adolescents, theoretically by decreasing stress-eating through altering executive functioning (EF) and food-reward sensitivity.

METHODS

N = 54 12-17y girls and boys at-risk for excess weight gain (i.e., BMI ≥70th percentile or two biological parents with reported obesity [BMI ≥30 kg/m2]) participated in a 1.5-year follow-up of a pilot randomized controlled trial comparing 6-week/6-session MBI (n = 29) and a health education (HE) control (n = 25). Laboratory stress-eating, food-reward sensitivity, EF, perceived stress, and BMI/adiposity were re-assessed at 1.5-years with validated measures. Changes from baseline to 1.5-year follow-up were explored with ANCOVA, accounting for the respective baseline outcome, age, and sex.

RESULTS

Compared to MBI (M = -21, SE = 59), HE had greater increases in stress-eating from baseline to 1.5-years (M = 194, SE = 63, Cohen's d = 0.59, p = .01). There were no other between-condition differences.

DISCUSSION

MBI may prevent worsening stress-eating for adolescents at-risk for excess weight gain. The potential for MBI as an intervention for stress-eating and ultimately, weight stabilization warrants testing in an adequately-powered trial.

Impulsivity and neural mechanisms that mediate preference for immediate food rewards in people with vs without excess weight

People with excess weight (overweight or obese; body mass index [BMI]>25) are generally characterized as impulsive with regards to food. However, the underlying brain mechanisms of this impulsivity are not fully understood. As such, this study aims at understanding the neural mechanisms underlying impulsivity toward food rewards, as well as differences in delay discounting patterns for hypothetical food between people with vs without excess weight. To this end, participants (79 college students, 33 with excess weight and 46 without) performed a food delay discounting task and completed questionnaires related to food addiction and impulsivity. In the task, we manipulated the magnitude of immediate and delayed rewards and employed event-related fMRI design to measure brain activity. The results showed that people with excess weight, compared to those without, were more impulsive and presented a lower probability of choosing delayed rewards. The higher the BMI was, the lower the probability of choosing delayed rewards was. People with excess weight also had higher impulsivity scores than people with no excess weight. Moreover, people with excess weight had less activation in executive function areas such as the anterior cingulate gyrus, the frontal pole, and the inferior frontal gyrus in both difficult and easy decision-making conditions. These results suggest that hypo-activation of executive function areas may contribute to the progression of decision impulsivity in relation to food, which in turn is associated with excess weight.

A review of effort-based decision-making in eating and weight disorders

Effort-based decision-making provides a framework to understand the mental computations estimating the amount of work ("effort") required to obtain a reward. The aim of the current review is to systematically synthesize the available literature on effort-based decision-making across the spectrum of eating and weight disorders. More specifically, the current review summarises the literature examining whether 1) individuals with eating disorders and overweight/obesity are willing to expend more effort for rewards compared to healthy controls, 2) if particular components of effort-based decision-making (i.e. risk, discounting) relate to specific binge eating conditions, and 3) how individual differences in effort and reward -processing measures relate to eating pathology and treatment measures. A total of 96 studies were included in our review, following PRISMA guidelines. The review suggests that individuals with binge eating behaviours 1) are more likely to expend greater effort for food rewards, but not monetary rewards, 2) demonstrate greater decision-making impairments under risk and uncertainty, 3) prefer sooner rather than delayed rewards for both food and money, and 4) demonstrate increased implicit 'wanting' for high fat sweet foods. Finally, individual differences in effort and reward -processing measures relating to eating pathology and treatment measures are also discussed.

The Relationship between Adults' Perceptions, Attitudes of COVID-19, Intuitive Eating, and Mindful Eating Behaviors

In total, 1224 Turkish adults (27.5 ± 9.6 years; 80.6% female) answered sociodemographic questions, and three instruments: Mindful Eating Questionnaire (MEQ), Intuitive Eating Scale-2 (IES-2), and COVID-19 Perception and Attitude Scale. Women's perceptions and attitudes toward COVID-19 indicated higher concerns than men (p < .001). It was found that IES-2 scores of all subjects increased as body mass index (BMI) decreased and education level increased (p < .001; p = .033, respectively). During the social isolation of COVID-19, the MEQ scores of married couples and those who did not eat take-out foods were higher (p = .027; p = .006, respectively). Interestingly, it was found that as the BMI of the subjects increased, their MEQ scores increased (p < .001). The COVID-19 pandemic, which has social and economic consequences, has a great impact on human health and causes sudden lifestyle changes through social distance and isolation at home. Although social isolation during the epidemic is a necessary precaution to protect public health, the results of this study support that it causes changes in intuitive eating, and mindful eating behaviors.

Temporal discounting as a candidate behavioral marker of obesity

Although obesity is a result of processes operating at multiple levels, most forms result from decision-making behavior. The aim of this review was to examine the candidacy of temporal discounting (TD) (i.e. the reduction in the value of a reinforcer as a function of the delay to its receipt) as a behavioral marker of obesity. For this purpose, we assessed whether TD has the ability to: identify risk for obesity development, diagnose obesity, track obesity progression, predict treatment prognosis/outcomes, and measure treatment effectiveness. Three databases (Pubmed, PsycINFO, and Web of Science) were searched using a combination of terms related to TD and obesity. A total of 153 papers were reviewed. Several areas show strong evidence of TD's predictive utility as a behavioral marker of obesity (e.g., distinguishing obese from non obese). However, other areas have limited and/or mixed evidence (e.g., predicting weight change). Given the positive relationship for TD in the majority of domains examined, further consideration for TD as a behavioral marker of obesity is warranted.

Delay discounting and obesity in food insecure and food secure women

OBJECTIVES

The relation between food insecurity (FI) and delay discounting (DD) and probability discounting (PD) for food and money was tested in women. In addition, discounting was tested as a variable that mediates the relation between obesity and FI.

METHOD

Women recruited from a community sample (N = 92) completed questionnaires. They completed the food choice questionnaire, the monetary choice questionnaire, measures for food and money probability discounting (which quantify sensitivity to risk aversion), and demographic measures.

RESULTS

Women with FI had higher rates of obesity and higher food DD compared to food-secure women. However, DD for money or probability discounting for food or money did not significantly differ between FI and food secure groups when controlling for significant covariates. Neither DD or PD significantly mediated the relation between FI and obesity.

CONCLUSIONS

These results suggest that FI is associated with greater impulsive food choice, but its association with other monetary discounting and probability discounting for food and money appears contingent upon other demographic factors. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impulsivity and self-control in elementary school children and adult females: Using identical task and procedural parameters

Results of studies examining the relationship between impulsivity and age are limited because different tasks, procedural parameters, and different reinforcers have been used with different aged participants. Thus, the current study sought to rectify these differences in two experiments with children (42, ages 5-12) and adults (69 college-aged females) using the same task with identical procedural parameters. In the Self-Control Video Software Task (SCVST; Forzano and Schunk, 2008; Forzano et al., 2014) participants repeatedly choose between larger, more delayed and smaller, less delayed access to viewing video cartoons. No differences in impulsivity were found between adults and children. No age or gender differences were found among children. Differences in task and procedural parameters are identified as important in their implications for research on impulsivity.

Multidisciplinary Approach for Weight Regain-how to Manage this Challenging Condition: an Expert Review

Weight regain is a multifactorial condition that affects many patients following bariatric surgery. The purpose of the paper is to review the multidisciplinary approach for the management of weight regain. We performed a search in current clinical evidence regarding the causes, consequences, and treatments of weight regain. The multidisciplinary approach with periodic monitoring is of fundamental importance to prevent or treat weight regain. Several therapeutic options are ranging from nutritional to surgical options, which should be tailored according to patients' anatomy, lifestyle behavior, and compliance. Specialized multidisciplinary care is the key to achieve optimal long-term weight loss and maintenance goals following bariatric surgery.

Delay and probability discounting in cocaine use disorder: Comprehensive examination of money, cocaine, and health outcomes using gains and losses at multiple magnitudes

Understanding factors associated with cocaine use disorder is important given its public health impact. One factor is delay discounting (devaluation of future consequences). Cocaine users have shown greater delay discounting of money rewards than non-cocaine users. But underexamined are factors known to affect discounting, such as the sign (reward vs. loss), magnitude (e.g., $10 vs. $1,000), and commodity (e.g., money vs. health) of the consequence. Also underexamined is probability discounting (devaluation of uncertain consequences). We conducted a comprehensive group-comparison study of discounting processes by comparing sign, magnitude, and commodity effects between demographically matched cocaine users (n = 23) and never users (n = 24) for delay discounting and sign and magnitude effects for probability discounting. Participants completed delay and probability discounting tasks spanning rewards and losses; money, cocaine, and health outcomes; and magnitudes of $10, $100, and $1,000. Four primary findings emerged when controlling for other drug use. First, cocaine users pervasively discounted delayed consequences more than never users regardless of sign, magnitude, or commodity, with the possible exception of delay discounting of $1,000 health equivalences. Second, both groups discounted delayed rewards more than losses, with a similar trend for probability discounting. Third, magnitude effects in cocaine users for delayed and probabilistic outcomes were similar to those previously observed in never users and other-drug users. Fourth, cocaine users discounted cocaine-related outcomes more than money and health, with variable results comparing money and health. These data suggest that the behavioral processes of delay and probability discounting are qualitatively similar for cocaine users and never users. However, quantitatively, cocaine users generally showed greater delay discounting and similar probability discounting compared with never users. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Adolescents Living with Food Allergies in Select Global Cities: Does a WhatsApp-Based Mindful Eating Intervention Promote Wellbeing and Enhance their Self-Concept?

PURPOSE

Food allergy prevalence in children and adolescents is increasing globally. Dietary restrictions are linked to the identities of food-allergic adolescents, which influences their wellbeing and self-concept. Mindful eating (ME) has been widely used to treat eating disorders. This study investigates whether WhatsApp-based mindful eating (ME) posts are effective for food-allergic adolescents in managing the condition, building self-concept and wellbeing.

DESIGN AND METHODS

A waitlist control design study was conducted with food-allergic adolescents (N _pre-test = 244; N _post-test = 215). Three measures were used to assess the outcomes pre- (T1) and post-test (T2): Mindful Eating Questionnaire (MEQ), Brief Psychological Wellbeing Scale for Adolescents (BPWBS-A), and Piers-Harris 2 Children's Self-Concept Scale (PH-2-CSCC).

RESULTS

The intervention was overall effective and more so for girls, middle class adolescents, with mothers as primary caregivers, whose primary caregivers had higher or postgraduate and professional qualifications, who were in turn also more likely to report no anaphylactic reaction and hospitalization emergency episodes at T2. Intervention compliance mediated the association between demographic predictors and outcome scores. Discriminant function analysis indicated stronger associations between certain predictors and subdomains of the self-concept outcome.

CONCLUSIONS

With adequate emphasis on intervention compliance and condition management, the WhatsApp-based ME posts would be effective for food-allergic adolescents.

PRACTICAL IMPLICATIONS

Pediatric nurses can recommend the intervention for community-dwelling food-allergic adolescents across contexts. Some refinements may be needed for boys, upper class adolescents, with father/kin as primary caregivers and less qualified parents.

Exploring the Environmental Manifestation of Types of Music on Reinforcing Mindfulness and Concurrent Calorie Intake

BACKGROUND

The role of music on energy intake is conflicting, and recent research has suggested a positive association between classical music listening and mindfulness.

OBJECTIVE

The purpose of the present study was to investigate the effect of music, specifically classical music on state mindfulness and calorie intake of energy-dense foods.

METHOD

One hundred participants were randomly assigned to either a classical, popular or no music condition, and were served a variety of sweet (i.e., chocolate and cookies) and savoury (i.e., crisps) energy-dense foods. Results: The results found no significant differences in state mindfulness, overall calorie intake, or intake of sweet foods across the three conditions. However, participants in the classical music condition did consume significantly less savoury food than those in the no music condition.

CONCLUSION

Playing classical music may be beneficial in reducing intake of savoury foods, but not through the association to changes in state mindfulness. Future research should explore extended sessions of music listening on state mindfulness and other experiential evaluations of mindfulness to conclude on the direct and indirect effects of music on sweet and savoury foods.

Delay discounting of different outcomes: Review and theory

Steep delay discounting is characterized by a preference for small immediate outcomes relative to larger delayed outcomes and is predictive of drug abuse, risky sexual behaviors, and other maladaptive behaviors. Nancy M. Petry was a pioneer in delay discounting research who demonstrated that people discount delayed monetary gains less steeply than they discount substances with abuse liability. Subsequent research found steep discounting for not only drugs, but other nonmonetary outcomes such as food, sex, and health. In this systematic review, we evaluate the hypotheses proposed to explain differences in discounting as a function of the type of outcome and explore the trait- and state-like nature of delay discounting. We found overwhelming evidence for the state-like quality of delay discounting: Consistent with Petry and others' work, nonmonetary outcomes are discounted more steeply than monetary outcomes. We propose two hypotheses that together may account for this effect: Decreasing Future Preference and Decreasing Future Worth. We also found clear evidence that delay discounting has trait-like qualities: People who steeply discount monetary outcomes steeply discount nonmonetary outcomes as well. The implication is that changing delay discounting for one outcome could change discounting for other outcomes.

Behavioral trainings and manipulations to reduce delay discounting: A systematic review

In everyday decision-making, individuals make trade-offs between short-term and long-term benefits or costs. Depending on many factors, individuals may choose to wait for larger delayed reward, yet in other situations they may prefer the smaller, immediate reward. In addition to within-subject variation in the short-term versus long-term reward trade-off, there are also interindividual differences in delay discounting (DD), which have been shown to be quite stable. The extent to which individuals discount the value of delayed rewards turns out to be associated with important health and disorder-related outcomes: the more discounting, the more unhealthy or problematic choices. This has led to the hypothesis that DD can be conceptualized as trans-disease process. The current systematic review presents an overview of behavioral trainings and manipulations that have been developed to reduce DD in human participants aged 12 years or older. Manipulation studies mostly contain one session and measure DD directly after the manipulation. Training studies add a multiple session training component that is not per se related to DD, in between two DD task measurements. Ninety-eight studies (151 experiments) were identified that tested behavioral trainings and manipulations to decrease DD. Overall, results indicated that DD can be decreased, showing that DD is profoundly context dependent and changeable. Most promising avenues to pursue in future research seem to be acceptance-based/mindfulness-based trainings, and even more so manipulations involving a future orientation. Limitations and recommendations are discussed to identify the mechanistic processes that allow for changes in discount rate and behavior accordingly.

Efficacy of a mindful-eating programme to reduce emotional eating in patients suffering from overweight or obesity in primary care settings: a cluster-randomised trial protocol

INTRODUCTION

Little is known about the applicability of mindfulness-based interventions in Spanish adults with overweight/obesity. The objective of the present study protocol is to describe the methods that will be used in a cluster randomised trial (CRT) that aims to evaluate the effectiveness of a mindfulness eating (ME) programme to reduce emotional eating (EE) in adults with overweight/obesity in primary care (PC) settings.

METHODS AND ANALYSIS

A CRT will be conducted with approximately 76 adults with overweight/obesity from four PC health centres (clusters) in the city of Zaragoza, Spain. Health centres matched to the average per capita income of the assigned population will be randomly allocated into two groups: 'ME +treatment as usual (TAU)' and 'TAU alone'. The ME programme will be composed of seven sessions delivered by a clinical psychologist, and TAU will be offered by general practitioners. The primary outcome will be EE measured by the Dutch Eating Behaviour Questionnaire (DEBQ) at post test as primary endpoint. Other outcomes will be external and restrained eating (DEBQ), binge eating (Bulimic Investigatory Test Edinburgh), eating disorder (Eating Attitude Test), anxiety (General Anxiety Disorder-7), depression (Patient Health Questionnaire-9), mindful eating (Mindful Eating Scale), dispositional mindfulness (Five Facet Mindfulness Questionnaire) and self-compassion (Self-Compassion Scale). Anthropometric measures, vital signs and blood tests will be taken. A primary intention-to-treat analysis on EE will be conducted using linear mixed models. Supplementary analyses will include secondary outcomes and 1-year follow-up measures; adjusted models controlling for sex, weight status and levels of anxiety and depression; the complier average causal effect of treatment; and the clinical significance of improvements.

ETHICS AND DISSEMINATION

Positive results of this study may have a significant impact on one of the most important current health-related problems. Approval was obtained from the Ethics Committee of the Regional Authority. The results will be submitted to peer-reviewed journals, and reports will be sent to participants.

TRIAL REGISTRATION NUMBER

NCT03927534 (5/2019).

Examining the Effects of Two Mindful Eating Exercises on Chocolate Consumption

Abstract. The present study aimed to investigate and compare the impact of the Mindful Construal Diary (MCD) and the Mindful Raisin Exercise on the sensory tasting experience of chocolate and participants’ chocolate consumption. Participants were randomly allocated into three conditions (MCD, mindful raisin exercise, and mindless control), and engaged with either the MCD, the mindful raisin exercise, or, were asked to read a news article, respectively, while they ate a piece of chocolate. They then rated their satisfaction and desire to consume more chocolate on a 10-point Likert scale, and filled in a state mindful eating scale. Afterward, participants were informed that the study had ended and were asked to wait while the experimenter recorded some information, and any extra chocolate consumption during this time was recorded. Participants in both mindfulness conditions consumed significantly less chocolate after the exercise than participants in the control condition. No significant differences were found between the three conditions on ratings of satisfaction and desire to consume more chocolate. Both the MCD and the raisin exercise can be used to successfully moderate the intake of calorific foods, while the MCD can be utilized as an alternative practice to the typical meditation-based interventions.

Mindfulness-based group intervention in adolescents at-risk for excess weight gain: A randomized controlled pilot study

OBJECTIVES

To assess feasibility/acceptability of a mindfulness-based approach to excess weight prevention in adolescents at-risk for excess weight gain. To pilot test efficacy of a mindfulness-based intervention for improving food reward sensitivity, stress-eating, executive function (EF), and BMI/adiposity.

METHODS

A pilot randomized controlled trial was conducted with 12-17y adolescents at-risk for excess weight gain based on above-average weight (body mass index [BMI]≥70%ile) or parental history of obesity (BMI≥30 kg/m2). Adolescents were randomized to a mindfulness-based (n = 29) or health education control group (n = 25) that met for six weekly one-hour sessions. Feasibility/acceptability were determined from attendance and acceptability survey ratings. At baseline, six-week and six-month follow-up, adolescents' perceived stress was measured with the Perceived Stress Scale, food reward sensitivity with a behavioral task, stress-eating during a laboratory test meal, and EF with the parent-reported Behavior Rating Inventory of Executive Function and NIH Toolbox. At the same intervals, BMI indices and body fat by air displacement plethysmography were assessed in a fasted state.

RESULTS

Median session attendance was 6:6 sessions in both conditions; program acceptability ratings were above-average. Compared to health education, adolescents in mindfulness had lower food reward sensitivity at six-months (Cohen's d = 0.64, p = .01). There were no between-condition differences in BMI (mindfulness vs. health educationΔsix-months 95%CI 0.20, 1.52 kg/m2 vs. 0.21, 1.62 kg/m2) or adiposity (-3.64, -0.61% vs. -4.31, -1.04%) changes.

CONCLUSIONS

A mindfulness-based group intervention is feasible/acceptable among adolescents at-risk for excess weight. In this pilot sample, mindfulness and health education were equivocal for BMI/adiposity outcomes. Future trials with a larger, adequately-powered sample and longer-term follow-up are necessary to test efficacy of a mindfulness-based intervention for food reward sensitivity, stress-eating, EF, and stabilizing growth trajectories in youth at-risk for adult obesity.

Overweight adults are more impulsive than normal weight adults: Evidence from ERPs during a chocolate-related delayed discounting task

Overweight or obesity can be accompanied by abnormalities in executive function and related neural markers. The aim of the present study was to investigate the behavioral and neural correlates of food-related decision-making in overweight and normal-weight adults. We used a delayed discounting task (DDT), which requires participants to choose between smaller immediate rewards and larger delayed rewards. In total, 24 overweight adults and 24 normal-weight adults participated; all participants engaged with a food-related DDT, and their responses were measured using event-related potentials (ERPs). In the current study, we take the area under the curve (AUC), number of smaller immediate rewards, and reaction times (RTs) as behavioral indicators of DDT. AUC is an individual's discounting rate, with smaller AUC reflecting more impulsive decision-making. Number of smaller immediate rewards also reflects impulsivity. For ERPs, N2, reward-related positivity, P3, and late positive component (LPC) were investigated. Behavioral results showed smaller AUC, more choice of smaller immediate rewards, and longer RTs in overweight adults than in normal-weight adults. Neural markers showed that overweight adults elicited greater N2 in larger delayed rewards than in smaller immediate rewards and also elicited greater reward-related positivity than normal-weight adults. Moreover, the P3 and LPC mean amplitudes of overweight adults were greater than those of normal-weight adults. Pearson correlation analysis showed that body mass index (BMI) was positively related to P3 and LPC, while AUC was negatively related to P3. The findings thus suggest that overweight adults are more impulsive than normal-weight adults. Moreover, overweight adults might experience more cognitive conflict before their reaction, and they might allocate more cognitive resources to food-related stimuli and might have higher-order cognitive processes more involved in motivation or emotion regarding food-related stimuli. This is the first study investigating ERP correlates of food-related decision-making in overweight adults, and it enriches the theoretical models by providing neural markers for future study.

Cognitive and behavioral training interventions to promote self-control

This review article discusses various cognitive and behavioral interventions that have been developed with the goal of promoting self-controlled responding. Self-control can exert a significant impact on human health and impulsive behaviors are associated with a wide range of diseases and disorders, leading to the suggestion that impulsivity is a trans-disease process. The self-control interventions include effort exposure, reward discrimination, reward bundling, interval schedules of reinforcement, impulse control training, and mindfulness training. Most of the interventions have been consistently shown to increase self-control, except for mindfulness training. Some of the successful interventions are long-lasting, whereas others may be transient. Most interventions are domain-specific, targeting specific cognitive and behavioral processes that relate to self-control rather than targeting overall self-control. For example, effort exposure appears to primarily increase effort tolerance, which in turn can improve self-control. Similarly, interval schedules primarily target interval timing, which promotes self-controlled responses. A diagram outlining a proposed set of intervention effects on self-control is introduced to motivate further research in this area. The diagram suggests that the individual target processes of the interventions may potentially summate to produce general self-control, or perhaps even produce synergistic effects. In addition, it is suggested that developing a self-control profile may be advantageous for aligning specific interventions to mitigate specific deficits. Overall, the results indicate that interventions are a promising avenue for promoting self-control and may help to contribute to changing health outcomes associated with a wide variety of diseases and disorders. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Role of delay discounting in predicting change in HBA1c for individuals with prediabetes

The majority of people with prediabetes transition to type 2 diabetes. Weight gain is a known predictor of increasing the risk of diabetes, but another reason may be a focus on immediate rewards and discounting of the future. Delay discounting (DD: devaluation of future consequences) is related to obesity and poor glycemic control in persons with type 2 diabetes. This study was designed to assess whether changes in DD are associated with HbA1c change beyond BMI change in individuals with prediabetes. Hierarchical regression showed changes in BMI (p = 0.008) and the $1000 DD task (p = 0.04) were associated with HbA1c change beyond demographic characteristics, with the full model accounting for 25.8% of the variance. Those with greater BMI increases and greater increases in discounting of the future showed the greatest increases in HbA1c. DD represents a novel target to prevent progression from prediabetes to type 2 diabetes.

Large-scale analysis of test-retest reliabilities of self-regulation measures

The ability to regulate behavior in service of long-term goals is a widely studied psychological construct known as self-regulation. This wide interest is in part due to the putative relations between self-regulation and a range of real-world behaviors. Self-regulation is generally viewed as a trait, and individual differences are quantified using a diverse set of measures, including self-report surveys and behavioral tasks. Accurate characterization of individual differences requires measurement reliability, a property frequently characterized in self-report surveys, but rarely assessed in behavioral tasks. We remedy this gap by (i) providing a comprehensive literature review on an extensive set of self-regulation measures and (ii) empirically evaluating test-retest reliability of this battery in a new sample. We find that dependent variables (DVs) from self-report surveys of self-regulation have high test-retest reliability, while DVs derived from behavioral tasks do not. This holds both in the literature and in our sample, although the test-retest reliability estimates in the literature are highly variable. We confirm that this is due to differences in between-subject variability. We also compare different types of task DVs (e.g., model parameters vs. raw response times) in their suitability as individual difference DVs, finding that certain model parameters are as stable as raw DVs. Our results provide greater psychometric footing for the study of self-regulation and provide guidance for future studies of individual differences in this domain.

Threat appeals reduce impulsive decision making associated with texting while driving: A behavioral economic approach

The primary purpose of the present study was to examine the effectiveness of threat appeals in influencing impulsive decision making associated with texting while driving. The participants in the treatment group were exposed to a threatening message about the danger of texting while driving, whereas those in the control group were exposed to a non-threatening message. Following the exposure to either message, the participants completed a delay-discounting task that assessed the degree of impulsive decision making in a hypothetical texting-while-driving scenario. A comparison between the groups revealed that the threat appeals reduced the degree of impulsive decision making associated with texting while driving. In addition, the threat appeals led to greater anticipated regret from texting while driving, less favorable attitudes toward texting while driving, and decreased intentions to text while driving in the future in the treatment group. These results suggest that video-based threat appeals are promising intervention strategies for the public health challenge of texting while driving. Implications from the behavioral economic perspective are discussed.

Healthy Eating: Approaching the Selection, Preparation, and Consumption of Healthy Food as Choice Behavior

Healthy eating has important well-being and financial implications for our society. As such, it is critical that the field of behavior science and behavior analysis conduct more research in this area so that effective interventions may be developed. One barrier to addressing healthy eating may be conceptual. Far from being a single response, eating is comprised of a series of choice responses. These selection, preparation and consumption responses form a temporally delayed behavioral chain. When designing interventions to address healthy eating, therefore, one must not only consider the specific target response, but alternative response options, and the effect of changing one response on other choices in the chain. The purpose of this article is to refine the analysis of healthy eating behavior, provide examples of research conducted in this area, and discuss how these interventions may influence this chain of responses. It is hoped that by doing so, additional research will be conducted and disseminated so that individuals, organizations, and policy makers can implement more effective interventions for healthy eating.

Experimental reductions of delay discounting and impulsive choice: A systematic review and meta-analysis

Many behaviors posing significant risks to public health are characterized by repeated decisions to forego better long-term outcomes in the face of immediate temptations. Steeply discounting the value of delayed outcomes often underlies a pattern of impulsive choice. Steep delay discounting is correlated with addictions (e.g., substance abuse, obesity) and behaviors such as seatbelt use and risky sexual activity. As evidence accumulates suggesting steep delay discounting plays a causal role in these maladaptive behaviors, researchers have begun testing methods for reducing discounting. In this first systematic and comprehensive review of this literature, the findings of 92 articles employing different methodologies to reduce discounting are evaluated narratively and meta-analytically. Although most of the methods reviewed produced significant reductions in discounting, they varied in effect sizes. Most methods were ideal for influencing one-off choices (e.g., framing and priming manipulations), although other successful manipulations, such as episodic future thinking, could be incorporated into existing therapies designed to produce longer-lasting changes in decision-making. The largest and longest-lasting effects were produced by learning-based manipulations, although translational research is needed to determine the generality and clinical utility of these methods. Methodological shortcomings in the existing literature and suggestions for ameliorating these issues are discussed. This review reveals a variety of methods with translational potential, which, through continued refinement, may prove effective in reducing impulsive choice and its associated maladaptive decisions that negatively impact quality of life. (PsycINFO Database Record

The effects of outcome unit framing on delay discounting

We examined the effects of outcome framing on delay discounting. In Experiment 1, participants completed four delay-discounting tasks. In one monetary task, money was framed in units of dollars (＄50), and in the other, money was framed in units of handfuls of quarters (equal to ＄50). In one food task, food was framed in clear units of food (e.g., 100 M&Ms), and in the other, food was framed in units of servings (e.g., 10 servings of M&Ms). When money was framed in units of dollars, participants discounted less by delay compared to discounting of handfuls of quarters. When food was framed as clear units, participants also discounted less compared to how they discounted servings. In Experiment 2, participants completed two delay-discounting tasks for dollars and quarters (e.g., ＄50 or 200 quarters) to determine if the results of Experiment 1 were due to the differences in handling costs. In one delay-discounting task, money was framed in units of dollars. In the other delay-discounting task, money was framed in units of quarters. There was no difference in how participants discounted delayed money framed as dollars or quarters. Clear unit framing may result in less discounting by delay than fuzzy unit framing.

Family-Based Mindful Eating Intervention in Adolescents with Obesity: A Pilot Randomized Clinical Trial

Mindfulness has gained attention in the treatment of obesity. However, there is a paucity of data on family-based training in mindful eating in children. The objective of this pilot randomized clinical trial was to evaluate the feasibility and acceptability of a family-based mindful eating intervention (MEI) in adolescents with obesity, and to compare the efficacy of the MEI versus standard dietary counseling (SDC) for decreasing weight and improving cardiometabolic risk markers. Twenty-two adolescents (age 14.5⁻17.9 years) and parent pairs were randomized to the MEI or SDC. The MEI was administered in four 90-min sessions over 10 weeks and SDC was provided at baseline, 12 weeks, and 24 weeks. Despite the requirement of more frequent visits with the MEI, adolescents and parents attended 100% of the sessions and there were no dropouts in that group. High density lipoprotein (HDL) cholesterol increased in the SDC group, but not in the MEI group. Adolescents receiving the MEI demonstrated an increase in awareness at 24 weeks (p = 0.01) and a decrease in distraction during eating at 12 weeks (p = 0.04), when compared with the SDC group. The family-based MEI showed feasibility and acceptability in adolescents with obesity. Future studies with more intense therapy and larger sample sizes are warranted to examine the role of mindful eating in treating pediatric obesity.

Self-Control in Intertemporal Choice and Mediterranean Dietary Pattern

Background: The Mediterranean Diet (hereinafter MD) is considered a healthy dietary pattern. Adherence to this pattern can be assessed by means of the KIDMED test by which individuals are assigned an index and classified into three groups of adherence to MD: high, medium, and low. In addition, impulsivity or impatience in intertemporal choice has been defined as a strong preference for small immediate rewards over large delayed ones. Objective: This study examines the relationship between dietary habits, specifically Mediterranean dietary pattern, measured by the KIDMED index, and the exhibited impatience in intertemporal choices, by means of the parameter k (discount rate of the hyperbolic discount function). Methods: A sample of 207 university students answered a questionnaire based on two tests: the KIDMED test, to assess the degree of adherence to MD, and an intertemporal choice questionnaire, to assess impatience or impulsivity. Individuals were grouped depending on their KIDMED score and then the discount rate or impulsivity parameter was calculated for each group. Results: Discount rates were inversely related to the degree of adherence to MD. The values of overall k were 1.53, 1.91, and 3.71% for the groups exhibiting high, medium and low adherence to MD, respectively. We also found higher k-values for larger rewards (magnitude effect) in the three groups. Conclusion: High adherence to MD is related to less steep time discounting, which implies less impulsivity (more self-control) or lower discount rates. Conversely, low adherence to MD is related to steeper time discounting, which implies impulsivity or higher discount rates. These findings could be used to identify the target population where policy interventions are needed in order to promote healthier diet habits.

Neural mechanisms associated with treatment decision making: An fMRI study

Great progress has been made in understanding how people make financial decisions. However, there is little research on how people make health and treatment choices. Our study aimed to examine how participants weigh benefits (reduction in disease progression) and probability of risk (medications' side effects) when making hypothetical treatment decisions, and to identify the neural networks implicated in this process. Fourteen healthy participants were recruited to perform a treatment decision probability discounting task using MRI. Behavioral responses and skin conductance responses (SCRs) were measured. A whole brain analysis were performed to compare activity changes between "mild" and "severe" medications' side effects conditions. Then, orbitofrontal cortex (OFC), ventral striatum (VS), amygdala and insula were chosen for effective connectivity analysis. Behavioral data showed that participants are more likely to refuse medication when side effects are high and efficacy is low. SCRs values were significantly higher when people made medication decisions in the severe compared to mild condition. Functionally, OFC and VS were activated in the mild condition and were associated with increased likehood of choosing to take medication (higher area under the curve "AUC" side effects/efficacy). These regions also demonstrated an increased effective connectivity when participants valued treatment benefits. By contrast, the OFC, insula and amygdala were activated in the severe condition and were associated with and increased likelihood to refuse treatment. These regions showed enhanced effective connectivity when participants were confronted with increased side effects severity. This is the first study to examine the behavioral and neural bases of medical decision making.